Healthcare Provider Details

I. General information

NPI: 1437385119
Provider Name (Legal Business Name): RAQUEL HULTQUIST B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E VALLEY PKWY SUITE D
ESCONDIDO CA
92025-3441
US

IV. Provider business mailing address

940 E VALLEY PKWY SUITE D
ESCONDIDO CA
92025-3441
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-0205
  • Fax: 760-747-0582
Mailing address:
  • Phone: 760-747-0205
  • Fax: 760-747-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: